SOLDIER STRESS AND PTSD

It’s Veteran’s Day and a good time to consider the plight of Our troops – especially given what they’ve been tasked to do in the service of The Greater Southwest Asia Co-Prosperity Sphere.

Tara McKelvey has a readable and substantive article in ‘The Boston Review’: is religion an obstacle to therapy for PTSD?

I’ve Posted on this recently, but it’s worth approaching the subject again from this slightly different angle.

She starts with the case of an Army chaplain (!) who had to report for PTSD treatment because he had reached a spiritual abyss after his recent tour over there and could no longer stomach hearing the phrase that ‘God is watching over you’. His wife and children afforded no effective consolation to him either.

I am always a bit wary of clergy – this one appears to be some flavor of Protestant – who ‘lose their faith’ when they run into the rough waters. Clergy – especially in the military – are supposed to be sort of like a spiritual Coast Guard: they’re always ready for the rough weather and boiling waves ‘out there’, and indeed sort of imagine that being able to provide service in precisely that dangerous and roiled environment is what the Coast Guard is all about.

So when one says that after running into some really rough weather s/he has lost the faith, then I begin to wonder if the individual was really clergy-chaplain material to begin with.

But then again, especially in this country of late, a sort of happy-face ‘summer sunshine’ sort of God, a glorified concierge there to fulfill one’s every wish, has been the usual image of the Divinity, and a sort of happy-face ‘summer-sunshine sort of life has been the usual expectation about the type of world such a God would set up (sort of like the Flower Children imagining that all of life was basically a dope-and-booze-and-sex-filled summer afternoon in San Francisco or Southern California).

But as a lot of folks and a lot of traditional theology and religion could have told them: it ain’t necessarily so … not hardly.

She refers to a recent study of Vietnam vets that indicated how many of the ones who had ‘lost their faith’ in God (and apparently the war) were most liable to return to the States and seek psychiatric counseling.

But of course, if you’ve lost your faith – to use the phrase – and thus don’t believe in God or religion any longer (and perhaps not in the goodness of the nation’s policy or the military brass) then you already defined ‘God and religion’ as being no longer of any help, even though what you have (your loss of faith) is primarily a spiritual problem.

Former students of a certain age may recall being taught that there are different types of fires, and so different types of extinguishers, so that – say – if you find yourself faced with an electrical fire, it won’t do any good to be putting water on it from the trusty water-based extinguisher.

But here, in this combat-stress matter, you have an electrical fire for which – since you’ve lost your faith in chemical powder – you’re going to try to put water on, turning to the water extinguisher by default as it were. Indeed, it may be a magnesium fire, for which water is not only an ineffective extinguishing agent, but will actually aggravate the fire and make it much worse.

This is a primarily a problem in the ‘rectification of Names’, as the ancient Chinese would say. Before you come up with the solution, you’ve got to accurately classify the problem.
But this has always been the problem of the ‘stress’ diagnosis from its inception about 30 years ago.

At the moment, the VA administration is still home to many hold-overs from the days of Bush and the ‘faith-based’ approach. That approach was a neat synergy between a government that didn’t want to waste money on cleaning up the consequences of its own actions and a Fundamentalism that essentially identified the country and the military and all their pomps and works with God: if you believe in ‘God’, the Fundamentalist whackery has it, then you believe in the country and the military and the war(s) and you shouldn’t be having any ‘stress’ at all. Your discomfort, in this approach, indicates a lack of faith.

Thus many chaplains – and they are so often Fundamentalists now - will start giving lectures on the Bible or – for those who are ‘with it’ – such current popular works as ‘The Purpose-Driven Life: What you need, soldier, is simply a stronger sense of purpose, not simply your own but the one God – through the President and your chain of command – has thoughtfully provided for you. So stop whimpering and start believing.

Oy. Oy gevalt. Oy and frak.

But accurate as it is to note the obnoxious and almost looney ‘ministry’ of Fundamentalist whackery, it is insufficient to stop the analysis there.

This ‘stress’ problem is a doozey of entangled developments: cultural and medical and political as well as religious and spiritual.

The VA hierarchy notes even now that the ‘stress’ diagnosis is a dubious one, and one that has unsavory political roots. There’s something to that.

In the later 1970s the Vietnam vets organizations started to carve a small place for themselves among the wider feminist push for ‘sensitivity’ to ‘pain’ – whatever pain a person (for the radical feminists, always a woman; for the multiculturalists anybody not ‘white’ and ‘mainstream’) might say that they felt.

This was considered to be a form of ‘empowerment’: instead of being told by a doctor (so often in those days a ‘man’) what your problem was and how to make it better, you would get to be listened to, and then your wishes as well as your pain would be ‘respected’ and you would thus be ‘empowered’.

Whether you would actually get better is another question, but then again this theory worked best with stuff that you ‘felt’. Broken legs and ruptured appendixes weren’t the best type of problems for this theory to prove itself; ‘pain’, however, worked very nicely: you felt it and you could declare when you no longer felt it (which was an outcome that didn’t seem to happen very often).

So the Vietnam vets started to get involved with this, casting their board on the rising surf.

Not that they didn’t have some frightening experiences. War itself, for the combat soldier anyway, is a frightening and awful cauldron. You can suddenly wind up ‘seeing’ an awful lot: not only carnage, but the darker side of nations, militaries, soldiering, and even your buddies.

And perhaps even yourself: if ‘seeing’ awful things is certainly a pressureful experience, even more so is ‘doing’ awful things – a cause of PTSD that, especially nowadays, isn’t mentioned much. Although I, for one, wonder just how many sufferers haven’t just ‘seen’ awful stuff but are haunted by what awful stuff they themselves might have done.

(A certain stock response to that insight is that it’s really just a form of ‘blaming the victim’, but if you can’t get an accurate cause of the pain (which is itself mostly self-reported and not accessible to scientific testing) then you can’t really devise an accurate treatment. If somebody, say, reports terrifying nightmares and crippling ‘depression’, and says that it is all from what s/he has ‘seen’, but you as a therapist don’t know that the person actually ‘did’ some really upsetting stuff as well as ‘saw’ stuff, then things aren’t soon going to get put right. And if you ‘witnessed’ some awful stuff but can’t report it because you want to be ‘loyal’, yet you still need to make the pain and stress go away … well, ditto ditto. You see where these things can go.)

So there was always a certain political element to this entire ‘disease’ called PTSD. Indeed, while the Diagnostic and Statistical Manual’s 1980 3rd edition put down some careful parameters for the particularly awful stresses generated by the combat experience, the 4th edition in 1994 expanded and diluted those parameters (to include some stressors, especially those connected with ‘men’, that the feminists’ clients – reputedly ‘all women’ – had to put up with). And the band played on.

But then there is a host of scientific problems with the diagnosis.

First, it has to be clearly isolated and differentiated from such other problems such as micro-sized brain damage (a current injury rampant in the current combat theaters): explosions such as those caused by IEDs and mines can cause tiny bits of damage in vital elements of the brain, causing all manner of physiological and psychological consequences. These injuries can now be seen on scanning equipment.

This is not PTSD, which is a far more fuzzy problem, since it appears to be a purely psychological and emotional response – by some soldiers but not others – to experiences they have had in the combat theater. Yes, the stress-released neurochemicals can, especially if the patient is exposed over a long period of time, cause physiological damage, but the neurochemicals are released by the individual’s sense of being ‘stressed’ in the first place. And we’re back to the individual and his/her ‘sense’ or ‘feeling’ of being ‘stressed’.

And then there’s the problem of self-reporting: if you can’t independently verify the existence of the ‘pain’ that the soldier is claiming, then you can’t really be sure of what you’re dealing with. The ‘solution’ to this conundrum – so popular in the victim-oriented 1980s and 1990s – was the simple and simplistic rule: believe the sufferer, since sufferers – through some metaphysical Law not previously published – do not lie or make mistakes.

This is conceptually a piss-poor professional standard of therapeutic practice. And especially in a situation where a putative patient stands to derive financial benefit – or in a military combat setting where a patient might be able to avoid ‘returning to the front’, then the possibilities for – ummmmm – mischief are huge. And of course, as victimism took hold in American culture, simply claiming the status of ‘victim’ was some sort of ‘benefit’, and to some might appear an actual achievement.

The solution precipitated out of the interaction with another development of the latter half of the 20th century: the development of numerous powerful drugs (and, it has to be said, the expansion of the drug and pharmaceutical industry). The most ‘efficient’ solution for a practitioner – and the one least likely to cost him/her a job – was to prescribe some drugs and get on to the next case of the day.

But as I said, if you’re dealing with primarily a spiritual or moral crisis – perhaps one induced by doing – rather than merely ‘witnessing’ – some awful stuff, then drugs were not really going to get to the cause of the problem. And if you’re dealing with a personality already weakened by immaturity or poor parenting and childhood experience (an increasing if disturbing probability in this country nowadays), then the introduction of drugs (and all their side effects) could only complicate an already complicated and somewhat nebulous situation.

And there is an organizational element to all of this in the military setting: a therapist is him/herself a sworn Service member, perhaps even a commissioned officer. So when the chain of command says that You will do this or You won’t do that … then your professional judgment has to take a back-seat to your orders. Unless you want to get court-martialed or be dismissed from the Service (which never looks good on a resume).

And in the current setting of combat operations the chances of ‘stress’ are very high indeed.

First, the nature of the combat: we are more or less losing, or at least involved in precisely that “long twilight struggle” that no American military commander has ever welcomed (We are a quick-and-total victory sort of nation). Worse, this is a war with no ‘front-line’: there is no in-theater ‘safe zone’ where you can be sent for a little R&R. Nor can the military afford to be shipping big bunches of troops to Europe or wherever for such R&R (it isn’t the Golden Age of 1945-1970 any longer). So the stress-inducing experiences never stop.

Second, the average American munchkin is not really conditioned to a lot of pressure. Preserved from a childhood of drinking water from garden hoses or riding bicycles without helmets, alert to the smallest official disregard of their ‘rights’ or their preferences, and wayyyy too sugared-up, there are just a whole lotta munchkins and munchkas that aren’t used to running up against a stern and implacable reality, like – oh, sayyyyy – war and combat.

And for far too long the military has catered to that cultural shift by watering-down the ‘stern and implacable’ side of training. Indeed, the feminist lobby insists that military service is primarily an ‘employment opportunity’ and since ‘it isn’t your father’s or grandfather’s (fill in the blank: Army, Navy, Air Force) any longer’, then it isn’t their type of ‘war’ either. Although if the lobby imagined that War itself – that awesome and aweful Horseman – was going to be as easily cowed as the US Congress, they were laboring under a delusion of truly world-historical proportions.

And then, coming full circle, there are now the Fundamentalists, who under the Bush Administration swelled to an Ascendancy in the military chaplaincies. They did so because they were far more government-friendly than any other faith-group, including the Catholics: in the simplistic Fundamentalist schematic, God appointed and deputized ‘the powers that be’, which is the government and the military chain of command, and so all the soldiery has to do to ‘get right with God’ is to follow orders. Ach!

Unfortunately, the same Congress that breezily pandered to ‘youth’ and other pushy lobbies over the course of decades, also signed off on a ‘war’ that bids fair to force all of the favored demographics into that “long twilight struggle” on the darkling, blood-red fields of Ares Ferox et Atrox.

Hence the possibilities for stress are legion.

And to complicate it all with one last infernal twist, the Fundamentalist chaplainry is actually making some good noises about self-discipline and responsibility that have been sorely deconstructed of late. (Which is not to say that I subscribe to any Fundamentalist vision of ‘maturity’, especially since their idea of history stops about 6,000 short years ago and their vision of the earliest hominids has those bipeds sharing turf with the dinosaurs, as was proven by that decisive historical evidence, “The Flintstones”.)

So it’s not hard to see where military therapy providers as well as service personnel are under a lot of pressure.

But the elements of the whole thing are numerous, convoluted, and present a massive and molten cauldron of complexity. And Americans have never been known to handle that type of challenge well.

If all this gives you a headache, I recommend that you don’t take an aspirin, but instead stay with the pressure and the pain and try to work through it. The more folks that get into that habit, the better the chance that somehow the country can come up with a reasonable analysis and some modestly effective solution.

Do it for the troops. God knows We owe it to them.

PURPLE HEARTS

A cry of outrage that the military will not award the Purple Heart medal to soldiers suffering from Post Traumatic Stress Syndrome (PTSD). Thus reports Conn Hallinan on Truthout.

The Pentagon accurately characterizes PTSD as “an anxiety disorder caused by experiencing or witnessing a traumatic event” and “not a wound intentionally caused by the enemy”.

Yet another unfolding of the consequences trailing upon a complicated problem and the not-entirely-above-board efforts to ‘solve’ it.

In the early 1980s PTSD was created as a diagnosis, duly voted into the “Diagnostic and Statistical Manual” (DSM), official bible of psychiatric and psychological practice. It arose in the context of Vietnam Vets, many of whom by then were 10 or even 20 years beyond their service in that unhappy misadventure.

We get into murky waters almost instantly.

Unlike a medical diagnosis (appendicitis, broken bone, gunshot wound), or even certain psychiatric diagnoses that have clear and observable physiological markers accessible to testing, PTSD’s diagnostic indicators were capable of being interpreted as the results of other causes, other issues, not the least of which was ‘faking’ the symptoms, but many of which included less ‘acceptable’ causes such as addictions, the cumulative consequences of bad habits, or poor life choices. Even in the 1980s, you didn’t want to get into the question of ‘characterological’ causes, since to do so would be ‘insensitive’ and would merely be ‘blaming the victim’.

It was a complicated moosh.

So matters remained as the diagnosis was embraced by assorted Advocacies, claiming that the constitutive, signature ‘outrage’ that sustained their ongoing ‘oppression’ was creating a non-military form of PTSD: in other words, the ‘trauma’ was not from an exposure to some chunk of war’s admitted horror that overwhelmed this or that individual soldier, but from experiences more in line with the view of its constituent’s lives put forth by this or that particular Advocacy. ‘Racism’ was said to create a form of PTSD, ‘gender oppression’ created numerous forms, and so forth.

It is a historically established fact that many soldiers have come back from America’s wars ‘not quite right’. After the Civil War, many veterans demonstrated what was called ‘soldier’s heart’; ‘shell shock’ was a World War One term and ‘battle happy’ a (more ominous) World War Two term.

Diagnostically, of course, the competent provider would want to know about symptom onset, including pre-combat or pre-military behavior and performance, to assist in determining the time of onset and perhaps shed much more light on the cause of the symptom. Politically, however, by the early 1980s it became ‘inappropriate’, ‘unprofessional’, and ‘outrageous’ to ask such questions – to inquire into the patient’s ‘past’. This was a bleed-over from various Identity-based legal strategies then (and still) in vogue, and from a particular pop-psychological ‘syndrome’ discovered in 1971 by a Boston College professor called ‘blaming the victim’.

The result was a ‘patient’ self-reporting a number of behavioral symptoms whose causes could quite possibly be other-than-combat, about which no questions could be asked to further refine the cause of the symptoms. Ethically, of course, this was a nightmare since a provider would have to provide ‘treatment’ for symptoms and complaints without necessarily being certain of the cause. But ethics – and professional canons – were rapidly coming to have nothing to do with it.

Now comes Iraq – that misbegotten frakfest – and soldiers are coming back not only with awful physical injuries, but with psychological issues. This is not surprising: the Fourth Generation Warfare and urban and occupation combat situations into which the troops have been dumped and left – for years now – generate intense pressures all their own. It was utterly forseeable.
And once again, it is a matter of determining what the cause might be (including, alas, the possibility that the cause pre-existed the military experience). But again, providers are limited in what they can ask.

And on top of it all, female troops are reporting such symptoms as well, and in high proportions to their numbers. And unless We presume that there is absolutely no truth to the proposition that females are more ‘relational’ and ‘sensitive’ than males, there exists some possibility that female troops in this type of situation are particularly prone to this, in a combat setting that is already psychologically chewing up very large numbers of males.

But, as any military medico will tell you, you can’t even go near that. In this respect We are on the wrong side of the Himmler-Eastern Front problem: since Party dogma defined the Russians as sub-human, then they were presumably not a threat and anything could be done to them. Party dogma was clearly insufficient as a guide to operations , the generals at the front mentioned that to Berlin, but Party dogma, the political element, overruled the actual experience and after a while the generals decided to shut up and keep their jobs. With catastrophic results for the Nazi campaign. When Party dogma starts to control military operations, then things will not end well. And as always, it will be the troops who take the brunt of the frak-up.

Now, on top of the deep-seated complexities and the long-standing mis-handling of the matter, there is a movement to award the Purple Heart to folks demonstrating such symptoms. Nor can it be further asked how the symptoms came to be.

By remarkable coincidence, a recent ‘study’ suddenly reports that “up to” (beware the vagueness) 320,000 troops are suffering from ‘Mild Traumatic Brain Injury’ (MTBI), just recently discovered. Amazingly, its symptoms are “almost indistinguishable from PTSD”.
To the reader who has learned from the dark and long suffering of the Soviet citizenry, there is much here. The “up to” is a telltale warning sign of that statistical sleight-of-hand called ‘extrapolation’: we don’t really know, but if we take a manageable sample, get a percentage, then we can apply that percentage to the whole group and come up with a (usually reeely reeely big) number.

The system has its uses, but it has to be deployed carefully and conscientiously. These are two characteristics not known to revolutionaries as ‘good’ when dealing with ‘emergencies’ and ‘outrage’. The revolutionary or advocacy strategy is simpler: get as many soldiers as you can find hereabouts, make your diagnosis as vague and broad as you can, make sure you get a high percentage of these soldiers here to acknowledge at least one of those vague symptoms, and then apply that percentage (especially if it’s high) to the number of members of the entire military. You get a huge number (320,000, say) and the average reader might assume that you actually have identified without a doubt 320,000 cases. But you haven’t. Not hardly. It’s worked in all sorts of Advocacy situations in the past few decades. It’s being used here now.

Second, why create a second ‘syndrome’, identical to the first and thus equally impossible to fully diagnose – especially given the politically sensitive limitations – when you can’t even handle the first diagnosis adequately?

The answer may well lie in a teensy little bit added by one of the researchers, a female chief of neurology at San Francisco General who has been “working with wounded soldiers at the Army’s Regional Medical Center in Landstuhl, Germany”. She has also, by the by, already written a text-book on MTBI.

In MTBI there is “injured tissue in the brain”. Aha – resolving the old PTSD problem that there were not necessarily any physiological injuries that could be detected by diagnostic equipment and examined. This is a game-changer.

Except – wait for it – MBTI doesn’t show up on CAT scans. Ah. As a Brit might tactfully intone: ‘Oh my’.

But the doc’s got that covered: “This is a complicated injury to the most complicated part of the body”. So we shouldn’t expect evidence or proof. Ovvvvvvvv course.

Except for the behavioral symptoms: ‘depression’, ‘uncontrolled rage’, ‘digestive problems’, ‘emotional disengagement’, ‘blinding headaches’, ‘memory loss’, and ‘sexual dysfunction’ are all mentioned. But surely, and the feminist advocacies especially back this up, such behavior has been demonstrated among males long before ‘Iraq’ – look at the domestic violence stuff, right? And ‘sexual dysfunction’ … has been around for a lot longer than anybody’s military service in Iraq or Afghanistan.

And, while the feminist advocacies will not want to discuss it, such symptoms appear to be fairly rampant among younger females, even in the Hamptons or Malibu.

Another psychiatrist, working with veterans’ families, offers more: “identity ambiguity”, she calls it. “People who were decisive become indecisive. People who were charming become withdrawn.” Sort of like when you were in the old Stages of Mourning back in the ‘70s.

Or, more interestingly, “soldiers who left as a good son, a good father, and a good husband, suddenly start hitting their [sic] children, can’t have sex, start drinking too much, talking too loud”. (She’s going for the mostly male angle, it seems.) This is hardly unknown in returning veterans. And especially to be expected when troops have been forced to not only undergo the sustained pressures of the very frakky warfare in Iraq, but also where troops have had to do things (kick in the doors of family homes, terrify civilians as a matter of operational policy) that no American soldier has ever been sufficiently prepared to do (thank God).

There are many professionals who don’t agree with the existence of MTBI. It is “a slippery beast”, as the article notes. And We have been handed wayyyyy too many slippery beasts – propositions, assertions, ‘facts’, numbers, ‘stories’ and ‘dreams’- for lo these past forty years. Good for them, but how long they’ll be able to hold out is another question altogether. We are in the condition We are in today – as a nation and a society – precisely because too many slippery things have been forcibly replacing the ‘solid’ things. And now it’s all slip-sliding away.

And of course, you don’t get far in modern ‘professions’ unless you can make a splash with your own ‘discovery’. And there’s always surfing to be done on the beach of Sensitivity, where an ‘appropriate’ Kowabunga is always in good form. Let’s give more troops a medal – they deserve something for what they’ve gone through over there. And this is a ‘diagnosis’ that will get them benefits (although where the VA and the government will get such sums nowadays is anybody’s guess).

But I think that there’s also an even darker scheme here. It’s a way to get females a medal that they can all win. And in that regard, I’d be interested to see what the Army’s latest general in striped pants and sensible shoes will have to say about all this – in fact, it’s a curious coincidence that she just took office and suddenly this gambit comes along.

In the military setting, the Purple Heart is an especially freighted medal. It says to everyone who can read the ribbons on your uniform that you’ve been wounded, clear and simple. Soldiers who have been shot or hit with shrapnel or have undergone such bloody assault are recognized by their military fellows for what they went through.

To award it to troops who have ‘no blood’ is not wise from a moral and organizational efficiency point of view. The shedding of ‘blood’ is, as it has always been, of uniquely intense significance – and those who have undergone such an experience (which the military requires all its members to be prepared for) must be recognized. Conversely, those who have not shed blood cannot be so ‘awarded’.

It might be a good thing to borrow the Canadian approach, as the article mentions: create a new medal. The Canadians have created the “Sacrifice Medal” for “those who have suffered mental disorders that are, based on a review by a qualified mental healthcare practitioner, directly attributable to a hostile or perceived hostile action”.

It’s an idea with some merit. If you have to go the route of giving an aware at all. But the Canadians have already had to sail into the trap: “a perceived hostile action” … ? So, if you think you were being shot at, and that alone created a trauma, then you get a medal for that. No, I won’t say it’s so ‘Canadian’, but it is soooo ‘sensitive’. And you can see how quickly the solidities of human motivation and performance, of human nature even, are jellified by the ‘sensitizing’, ‘medicalizing’, feminisitifying tendencies of the past decades. While holding no brief for Pentagoons, I can see why they’re trying to keep Second Wave Party dogma from doing to us something along the lines of what was inflicted on the Wehrmacht by its own version of the Beltway, by ‘Behr-leeen’ as the Nazis used to say in the old war movies. We call Ours ‘the Beltway’.

It also smacks of the last 40 years of education 'reform': nobody flunks and everybody gets a little gold star on their forehead for self-esteem.

Worse, I can see this going the way of the abortion ‘medical certification’. If you can get a doctor to say that carrying the fetus to term is going to upset you greatly, then you qualify for an abortion. Many doctors will, and the Advocacy is now trying to make sure that all of them must.

So much turning to jelly. But that problem, at least, has a clear and identifiable cause. If We can take the appropriate action. But for too many, the disease is better than the cure. Less stressful. Feels better.

This is not a recipe for survival – as adults, as a society, as a culture, as a civilization, as a nation.